34DD Breast Reduction and then Pamela Anderson Implants

if this is what you seek, it is likely you will require an agressive reduction followed by staged large subglandular (over the muscle silicone implants). Be prepared for scars/

You may just wnat to go with a lift of your breasts for now and see how they look,. If you feel that they are not large enough, than opt for an implant to be added.

There is a relatively new way of providing an extreme lift on very saggy breasts.  GOOGLE Rubin Mastopexy and you will see the astonishing results using your own tissue.  It can also be tailored to allow for a limited reduction of tissue and remove a lateral chest roll if one is present.  If you do choose this route, it is doubtful you can have an augment later.

This mastopexy takes 4.5-5 hours over the usual 2.5-3 hours.  By choosing this route, you will avoid all of the risks that come with implants, including more surgeries in your future to keep an augmented breast "perfect".

I do this combination frequently, first a reduction/lift than 6 weeks to 3 months later an implant operation. Most are very satisfied with the results

There are situation like what you describe that require a reduction, lift, and augmentation. The ideal approach would be to idealie the breast from a reduction and list, then choose the implant that will produce the desired look. I will often do this simultaneously but you should be advise of potential increased risk and possible need for touch-up or revision when multiple elements are changed all at once.

The firm, rounded look usually does require implants in my experience. I'd recommend a consultation with a board ceritfied plastic surgeon who can look at your anatomy and body composition in person and give you his or her best advice.